Raynaud's disease in children.

Six children with primary Raynaud's disease have been studied with plethysmography and multiple-site skin-temperature readings. All six were free of systemic disease. Each demonstrated the characteristic sequence of pallor, cyanosis, and rubor when subjected to generalized cold, but application of local cold produced only modest reduction in skin temperature and digital pulse. Only one child had a history of vasospastic symptoms associated with emotional stimuli, and she was the only one in whom an emotional challenge was able to produce Raynaud's phenomenon during the physiological studies. Tolazoline, in doses small enough to avoid generalized vasodilatation, was effective in substantially increasing flow to the affected digits. The involvement of only one or two digits, next to completely uninvolved digits, is a conclusive argument for a primarily local sensitivity. However, the ability to precipitate vasospasm with generalized cold, versus local cold applications, and emotional stimuli indicates the importance of the nervous system in the manifestation of Raynaud's disease.